A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal hypertension. The nurse recognizes which of the following laboratory findings as indicating the client's gastrointestinal (GI) tract is digesting and absorbing blood?

Rationale:
A. Serum calcium levels are often decreased in acute pancreatitis due to fat saponification, not increased.

B. Serum lipase is typically elevated, not decreased, in acute pancreatitis, and is often more specific than amylase for pancreatic injury.

C. WBC count usually increases due to inflammation and possible infection; a decreased WBC is not expected.

D. Increased serum amylase is a hallmark laboratory finding in acute pancreatitis. Amylase is released from damaged pancreatic cells into the bloodstream. Levels typically rise within 6–12 hours of onset of symptoms and remain elevated for 3–5 days. Monitoring amylase, along with lipase (which remains elevated longer), helps confirm the diagnosis and assess the severity of pancreatic inflammation. Elevated amylase, in the context of abdominal pain radiating to the back, nausea, and vomiting, supports the provider’s suspicion of acute pancreatitis.

Rationale:
A. Tap water enemas are hypotonic, and repeated or large-volume use can lead to hyponatremia or other electrolyte disturbances, particularly in infants, elderly clients, or those with renal or cardiac issues.

B. Administering a tap water enema in a client with suspected appendicitis can increase intra-abdominal pressure, potentially causing perforation or worsening the condition.

C. Tap water enemas can further disrupt fluid and electrolyte balance in clients who are already dehydrated, exacerbating their condition.

D. Regular use of laxatives is not a strict contraindication for a tap water enema but may reduce its effectiveness over time due to bowel adaptation.

E. Clients with recent bowel surgery or structural abnormalities are at higher risk for perforation or injury when receiving an enema.

F. Tap water enemas are not indicated for clients with normal bowel function because they are unnecessary and can cause discomfort or dependence.

G. While maintaining hydration is important, it does not contraindicate the use of a tap water enema; it may actually support bowel function.